Population-Health-Environment (PHE) Champions-Local Leaders: Role Models for the World

firefoxThe Danajon Bank, which is located off the northwest coast of Bohol Island, is the sole double barrier reef in the Philippines and 1 of only 3 such sites in the Indo-Pacific region. It consists of three large reefs spread across 273 square kilometers believed to have been formed over the last 6,000 years. The Bank's situation inside an 'inland' sea, the Camotes Sea, contributes to the high diversity of coral species. The Bank is a large breeding area for many species of finfish, shellfish and invertebrates. If managed well, the Danajon's productivity could be worth US$ 8 million per year. In recent years, however, the Danajon Bank has been subjected to extremely high fishing pressure largely through illegal as well as destructive fishing methods. Fisheries outside of the shallow reef areas are also heavily exploited by a combination of small-scale locally based fishers and commercial fishing boats that fish illegally inside municipal waters1. For these reasons, the Danajon ranks among the country's extremely high priority areas for conservation of marine biodiversity2.

Four provinces have jurisdiction over the Danajon's resources e.g., Bohol, Cebu, Leyte and Southern Leyte. About 1 million people reside in the 15 municipalities and two cities that border the Danajon, where population density averages 445 persons per square kilometer compared to 286 for coastal Philippines and 313 for the whole country. There are 72 thousand households in the area with an average household size of 5 members per household. Ubay is one of the municipalities in Bohol located in the vicinity of the Danajon Bank. Ubay's population, which totaled 65, 900 in 2007, is expanding at an annual rate of 1.34% [NSO, 2007] and contains a large proportion of young people that renders high momentum to the population. Fishing communities in the Danajon Bank rank among the poorest in the province while malnutrition affects about 30 percent of children under age five. They also have very limited livelihood options and inadequate access to basic services such as water and electricity. For many generations the people living in the vicinity of the Danajon depended upon its marine and coastal resources for food, recreation and livelihood. The combined effects of declining ecosystem productivity, dwindling fish catch rates and increasing demand for aquatic resources from a growing population all contribute to the emerging crisis in food fish security which is exacerbating poverty, malnutrition and conflicts among resource users in the Danajon Bank.

In 2005 PATH Foundation Philippines, Inc.'s (PFPI) implemented the Integrated Population and Coastal Resource Management (IPOPCORM) Project in Ubay to redress the interrelated population, health and environment dynamics in communities surrounding the Danajon. IPOPCORM's overall strategy follows directly from the integrated coastal management (ICM) framework for fish food security developed by the Philippine government which calls for decreasing population pressure on the resource base in coastal communities as element of reducing fishing effort to sustainable levels3. IPOPCORM works to strengthen capacity at the local level in government, NGOs and peoples' organizations towards self reliance, stewardship of environmental resources and better management of reproductive health. IPOPCORM builds the capacity of local institutions and communities to implement a package of services in a coordinated fashion that conserve marine biodiversity, expand family planning access and improve human health and wellbeing. It also encourages local policy makers to integrate RH management into CRM agendas for improved food security. Although funding for the IPOPCORM Project in Ubay ended in 2007, the local government and communities have sustained the interventions and the area now serves as a "learning site" where executives from government and nongovernment organizations (both domestic and international) are brought to learn first-hand about the IPOPCORM approach.

One of the key factors for the success of the IPOPCORM project in Ubay was the support and cooperation of the local government unit headed by its Municipal Mayor, Dr. Eutiquio Bernales, a Leadership Development for Mobilizing Reproductive Health (LDM) fellow and one of the participants to the Institute of International Education-Leadership Development for Mobilizing Reproductive Health (IIE-LDM)-sponsored study tour for policymakers on integrated Population–Environment and Development in Thailand. Mayor Bernales' all out support for IPOPCORM was one of the catalysts for its success. The LGU of Ubay through his leadership has been hosting various study tours with local and foreign participants. Ubay is now being showcased as a "learning site" for new and emerging leaders of PHE. Over 200 public and private executives from the Philippines and other countries in Asia and Africa visited Ubay and were encouraged by the initiatives led by Mayor Bernales and his team.

The leadership of Mayor Bernales had multiplier effects in his locality and beyond. Not only did Mayor Bernales influence emerging PHE leaders from outside his municipality. He also had a team of PHE champions: Ms Mercedes "Mercy" Butawan, the midwife at the Rural Health Unit- 1 who has been with the RHU serving the people of the municipality of Ubay for more than ten years and promoting integrated PHE, and Mr. Alpios "Jojo" Delima, Ubay's Coastal Resoruce Management Officer who is now an advocate for PHE in his work and to others. Now, they do not talk only about health and CRM but also the importance of family planning in properly managing the coastal resources. Their leadership provided support for integrated approaches to PHE and increased reproductive health options and services in local communities not only in the municipality of Ubay but also in neighboring towns.

PHE champions like Mayor Bernales, Mercedes Butawan and Alpios Delima are a few of the leaders who were keys in making IPOPCORM one of the most successful PHE initiatives in the Philippines. Apart from these three PHE champions, there are other PHE leaders in the community such as the Peer Educators and Community-Based Distributors who in their own small ways continuously build constituency for integrated PHE approach by voluntarily and unselfishly sharing their time in providing PHE information and services to members of their respective communities. They are PHE leaders and their stories will hopefully inspire others to become champions of sustainable development in their areas. In one of the most recent south to south study tours organized by the USAID-financed Building Actors and Leaders for Advancing Community Excellence in Development (BALANCED) Project, after the visit to Ubay, one of the participants said, "The leadership and cooperation of the local government is the secret of the success of the IPOPCORM project. There is no success without the support of the local government and the acceptance of the community." One of the international delegates stated, "One lesson I take home is the cooperation of the government, technocrats, NGOs and the people. The real dedication of the government and not only doing lip service but contributing financially to the program are hallmarks of the program that we can't do without." Another international delegate described, "The approach shown is a new experience, a new way of life. Most programs are similar to my experience but impressed by the leadership shown from the municipality to the barangay (village) level."

Cascades of Leadership


Hon. Mayor EUTIQUIO BERNALES, MD4

INTEGRATED POPULATION-HEALTH-ENVIRONMENT (PHE): AN EFFECTIVE STRATEGY ON GOOD GOVERNANCE IN UBAY, BOHOL, PHILIPPINES

firefoxAs early as the 1980's, a significant decrease in fish catch had been noted by the fisher folks in Ubay, a coastal municipality in the Province of Bohol. This was a result of rampant illegal fishing, increase in the number of fishers and encroachment of commercial fishers in the area. Moreover, indiscriminate disposal of waste by commercial fishing vessels in the coastal and foreshore areas caused destruction of coral reefs and pollution of municipal waters. To address this, the local government unit (LGU) of Ubay initiated the rehabilitation of the coral reefs and marine species with the help of local NGOs and communities.

"The thrill of blast or dynamite fishing is brought by the explosion and seeing a school of fish lay like a mat at the bottom of the sea," Mayor Bernales remarked. "I admit that I once took part in blast fishing during my teenage days and it opened my eyes to the harmful effects and consequences of blast fishing as well as to the reasons why fishers engage in illegal fishing activities. This experience became a strong motivation for me to put up a PhP1.2 million municipal budget for coastal resource management (CRM) and to strongly support the integrated approaches in managing our coastal areas," Mayor Bernales explained further.

firefoxIn 2005, PATH Foundation Philippines, Inc. (PFPI) collaborated with the LGU of Ubay to implement the Integrated Population and Coastal Resource Management (IPOPCORM) project in selected barangays. Being an avid supporter and advocate for coastal resource management, the IPOPCORM project gained instant support and acceptance from the Mayor. "The rapid population growth in the coastal areas of Ubay has largely contributed to overfishing as a means of livelihood and food source which needs to be addressed to prevent further damage to the marine and coastal resources," Mayor Bernales pointed out. He believed that the integration of population, health and environment can improve the quality of life in the coastal communities by reducing the pressure on the coastal ecosystem and attaining food security. Determined to alleviate poverty among his constituents, Mayor Bernales took bold steps to attain this goal.

"With the integrated PHE approach, we are not gunning for birth control, but for birth spacing, not only to give the mother time to recover from her delivery and to give the infant her undivided attention for a longer period but more importantly to reduce human pressure to the not infinite resources from our seas and that includes Danajon. Besides, integrated PHE approach provides more savings to the coffers of the LGU which allows the municipality's policymakers and development planners to budget for the LGU's other needs without spreading the LGU's already meager resources too thin. Moreover, I believe that the integrated PHE approach and program is one of the factors that made Ubay progressed from third class municipality in 2004 to first class municipality in 2009," Mayor Bernales stressed.

firefoxMayor Bernales believes in the participatory approach in planning and constituency capacity building. Thus, he involved the community in the conceptualization of the municipality's five-year integrated CRM plan and the formulation of a CRM ordinance. Through the LGU's initiative, the fishermen's associations and the Federation of Bantay Dagat (fish wardens) were capacitated on monitoring and evaluation, and assessment of CRM- related activities. The multisectoral Barangay and Municipal Fisheries and Aquatic Resources Management Councils (B/MFARMC) were activated to serve as an advisory body on CRM-related policies. The Coastal Law Enforcement Council (CLEC) with members both from the environment and health sectors were also organized and activated. He also initiated the integration of Reproductive Health/Family Planning (RH/FP) and Environment-friendly Enterprise Development (EED)/Alternative Livelihood in the CRM program of the municipality. In December 2005, the IPOPCORM project and the LGU of Ubay through Mayor Bernales called for a municipal CRM, RH and Gender Planning Workshop participated by Municipal Planning & Development Coordinator, Municipal Health Officer, Municipal Agricultural Officer, Municipal CRM Officer, Municipal Planning and Development Coordinator, MFARMC President, 21 coastal Barangay Captains and trained peer educators of the IPOPCORM project. The workshop was geared towards assessing the current coastal situation of Ubay and reviewing of the Comprehensive Land Use Plan, Coastal Resource Management Plan and Municipal Health Plan to make sure that the plans include population dimension.

The Municipality of Ubay is the first town in the province of Bohol to adopt an integrated and comprehensive ordinance for Reproductive Health Care Code that was formulated and approved by the Municipal Council during the term and under the leadership of Mayor Bernales. This RH Care Code pursues sustainable human development that values the dignity of the total human person and affords full protection of people's rights, especially of women, children, youth and families. Mayor Bernales also strongly supported the establishment of teens' healthquarters in the municipality and in all high schools including sectarian schools. Moreover, he also made the government department heads of Ubay aware of the gender-responsive framework for analyzing the demographic aspects of population, health, environment, energy sources, food adequacy & nutrition, education, employment, housing, physical infrastructure and peace & order.

"I will do whatever I think is right and for the welfare of my constituents who rightfully deserve my services and to whom I am and will forever be indebted. I listen to the people from all sectors and consider their suggestions and opinions, because I believe in participatory approach; but no one can ever dictate me insofar as my governance is concerned. I have proven that, when I got criticisms and opposition from the Catholic Church and some conservative groups for openly and actively supporting programs and projects with population management component. Good governance is about making decisions with the ultimate end-result that would benefit neither me nor just a few but the majority, as long as it is within the bounds of law. That is also the reason why I decided to support integrated PHE approach to sustainable development in Ubay because I strongly believe that this is good governance," Mayor Bernales uttered when asked what for him good governance in relation to PHE is all about. He also mentioned that because of the integrated PHE program and strict implementation of fisheries laws, there is improvement of fish catch for marginal fishermen in Ubay which increased from 3 to 4 kilos in early 1980's to more than 10 to 12 kilos at present; increased size of fish caught in municipal waters; and increased awareness of the communities on PHE links and the benefits of managing coastal resources and population in an integrated fashion.

Along the way in his administration, Mayor Bernales encountered opposition from different sectors including some members of the Municipal Council regarding some of his decisions. However, he did not allow this to dampen his will, believing that the outcome of these decisions would benefit the majority of his constituents. In due time, this determination earned the respect of fellow politicians regardless of political affiliation. With the support of the LGU, reproductive health/family planning linked to coastal resource management eventually gained acceptance and support from the community. Mayor Bernales brushes aside the Catholic Church's opposition to RH/FP advocacy. "The priest's responsibility is to take care of the spiritual and moral values of the people, while the Mayor's is to look after the physical and basic needs of the people," he once said in a meeting with the parish priest.

firefoxMayor Bernales also strongly advocates for support to integrated PHE with other executives from government and non-government organizations both local and international which he usually does during symposiums, conferences, meetings, cross visits and even in informal and casual discussions. He shared with them the benefits and the experience of Ubay on integrated PHE program. Mayor Bernales is determined to continuously support integrated PHE in Ubay and encourage other LGU officials to do the same. His advocacy on integrated PHE is beyond words because he does not only talk about it but also practice it and do it by example. Mayor Bernales said with conviction, "With integrated PHE approach, you cannot go wrong. I strongly believe that integrated PHE is good governance and because of that I will continue to encourage other local officials, both local and international, to support integrated PHE in terms of programs and policies even beyond my term as the local chief executive of Ubay. I know that I will not be the leader of Ubay forever but with integrated PHE or IPOPCORM I know that Ubay's development will continuously soar high and with that I'll be able to leave a legacy that will last beyond my lifetime."

MS. MERCEDES BUTAWAN5

MAKING INTEGRATED PHE WORK TOWARD HEALTHY POPULATION, WEALTHY COMMUNITIES AND HEALTHY ENVIRONMENT

firefoxMayor Bernales' belief in PHE approach fostered a team of PHE leaders in Ubay and one of them is Mercedes "Mercy" Butawan, the midwife at the Rural Health Unit (RHU). When IPOPCORM was implemented in Ubay from 2005 to 2007, she actively participated in all its activities and served as a catalyst to gain the support of the local government officials and the community. "When the LGU of Ubay headed by our Municipal Mayor expressed support to integrated PHE program such as IPOPCORM, I did not have second thought or hesitation of doing the same because I knew that Mayor Bernales and other LGU officials did that for the good of Ubay and for the welfare of the Ubayanons," said Mercy.

firefoxWhen IPOPCORM was turned over to the LGU in 2007, with supervision from the Rural Health Physician of Ubay, Dr. Retchi del Mar, she continued to monitor the activities of the IPOPCORM trained peer educators and community based distributors who continued to educate and motivate their peers and distribute family planning commodities. She also conducts regular meetings with the community volunteers to discuss the challenges that they encounter in the communities. She also delivers family planning commodities from the PopSHOP6 which is based at the RHU to the community-based distributors (CBDs)7 to continuously make integrated PHE and FP information and commodities available and accessible to the people in far flung subvillages. Her dream of making all the barangays (villages) that she covers become "model communities" gives her the energy to work harder and face all the challenges that come her way with a positive attitude.

"Integrated population, health and environment programs and projects such as IPOPCORM make both the community and the environment healthy which is what happened in Ubay. The integration of population, health and environment in Ubay resulted to planned and well managedfamilies and coastal resources, more food for the people, decrease in the number of malnourished children, less cases of unplanned and teen pregnancy, decrease in the number of fishers engaged in illegal fishing practices and increased awareness of the people on the benefits of managing both the population and the environment at the same time. It also gave me hope that Ubay would be able to triumph all its problems related to population, health and environment, and for the first time in my life, amidst all the problems in Ubay, I was able to see light at the end of the tunnel." This is how Mercy briefly described the benefits that the community and herself gained from a community-based integrated PHE project implemented in the municipality of Ubay.

firefoxShe also encountered opposition from the Catholic Church and some conservative groups in supporting and implementing PHE activities but she did not let this dampen her spirit and zeal to serve the people in her barangays and realize her dream of establishing model communities. "I brush aside the opposition and criticisms I get from the Catholic Church and conservative groups because I firmly believe that an integrated PHE program such as IPOPCORM is the key to realize my dream of making my barangays as model communities. I believe it has all the ingredients needed to address most if not all of the problems in the municipality of Ubay in general and in the barangays in particular especially those problems related to population, health and environment including poverty and climate change," she shared.

"It opened my eyes and made me realized that health problems are not just merely health problems, and that the causes of our problems are interrelated. Before, PHE link for me is just a concept but now I can see in my own eyes how PHE is being linked in practice. It is now clear to me how problems in the environment affect us and our health and vice versa. Now, I do not only talk about health but rather discuss health in relation to the environment or coastal resources and more importantly I can now walk the talk. My exposure to integrated PHE widened my horizon and made me think about interrelated out-of-the-box solutions to interrelated problems on population, health and environment," Mercy further shared.

Mercy also added, "Sharing about integrated PHE particularly our experience and the benefits that the municipality of Ubay and our barangays gained was truly a fulfilling and rewarding experience for me. Through this and with the cooperation of local institutions such as the municipal and barangay local governments, the rural health unit and the CRM office, and most especially the unselfish support of community volunteers, I was able to gradually encourage other people especially the other midwives, barangay health workers and some other local officials here in Ubay and those from other provinces and municipalities who visited Ubay to support integrated PHE by initiating discussions on PHE links, discussing about health in relation to and/or in tandem with coastal conservation, initiating integrated PHE programs and projects, and formulating policies to advance PHE integration."

firefoxMercy's passion and commitment to improve the lives of people in Ubay never wane and she is determined to make it happen which she said is actually happening, slowly but surely. Mercy further said, "I know that integrated PHE approach to development will result to healthy and wealthy families and healthy environment because that is what we have been experiencing here in Ubay particularly in the barangays that I have been serving. Furthermore, my dream of making my barangays as model communities is now gradually being realized. I am hoping that other municipalities here in the Philippines and even in other countries will follow what we have been doing so that they will also experience what we have been experiencing here in Ubay as a result of implementing integrated PHE projects and programs."

MR. ALPIOS DELIMA8

INTEGRATED POPULATION-HEALTH-ENVIRONMENT: STRATEGIC APPROACH TO SUSTAIN CONSERVATION GAINS

firefoxMayor Bernales' support and advocacy for PHE approach influenced emerging PHE leaders in his municipality and outside and one of them is Alpios "Jojo" Delima, Ubay's Coastal Resource Management (CRM) Officer. He is now an advocate for PHE in his work and to others. Now, he does not talk only about CRM but also the importance of family planning in properly managing the coastal resources for habitat enhancement, ecosystem rehabilitation and sustainable food supply.

He was actively involved in IPOPCORM activities when it was first implemented in Ubay in 2005. "I believe in Mayor Bernales' governance as well as in his commitment and dedication to improve the socioeconomic, health and environmental situation in Ubay that's why I'm also supporting all his ideas and programs including the integrated PHE approach to sustainable development such as the IPOPCORM," Jojo said. He first came to know about integrated PHE when he met IPOPCORM Project Director Dr. Joan Castro in one of the workshops he attended in 2003 and from then on he gradually became one of the supporters of integrated PHE. With the IPOPCORM, Jojo became not only an advocate of CRM but also of family planning/reproductive health. Now, he talks about family planning and how integrated PHE lends sustainability to conservation efforts including the benefits that reproductive health/family panning provides to environment and conservation activities.

firefox"I came to realize that all our efforts and conservation gains would be futile and negated if population management would not be implemented in an integrated fashion with coastal resource management. Before, I observed that no matter how diligently we managed our resources, I still observed that destruction of coastal resources continued and there was only little improvement in fish catch. Integrated PHE approach coupled with strict implementation of environmental and coastal laws and ordinances really makes a difference. The LGU of Ubay has now gradually but significantly reduced illegal fishing activities in the municipal water under its jurisdiction which resulted to significant increase in fish catch and healthier coastal habitats and communities. More importantly, the people of Ubay or the Ubayanons are now more aware about the PHE linkage and how a well planned and healthy family contributes to the management of coastal resources and vice versa," Jojo said.

firefoxJojo also unselfishly shares to other people especially those who are also involved in coastal conservation, the importance and benefits of the integrated PHE approach and program. Whenever he talks about coastal resource management he never forgets to mention the relationship between population, health and coastal resources. "Even the bantay dagat (fish wardens) and members of the Coastal Law Enforcement Council (CLEC) can now talk about the benefits of practicing family planning in the management of coastal resources. By providing information on integrated coastal resource management, family planning and health, they can now help in changing positively the attitude of the communities toward family planning, health and coastal resource management and making them actively participate in managing their families and the environment," Jojo proudly mentioned.

For Jojo, sharing his thoughts, ideas and knowledge about integrated PHE together with the frontliners on population management and being able to mobilize people to commit their time to worthwhile activities to uplift their lives and improve their situation are very fulfilling undertakings. He hopes that other people especially those involved in conservation like him will someday see the beauty of integrated PHE approach and eventually realize that integrated PHE approach really makes sense. With what Jojo has been doing, he continuously aspires to be a role model in society by inspiring and motivating other people to always do their best for the good of their families and their communities.

firefoxJojo believes that the integrated PHE approach to coastal resource management such as IPOPCORM has been one of the major causative factors why there is increase in fish catch, less number of fishers engaged in illegal fishing, more families that are healthier and well managed, and the improving condition of the coastal resources in Ubay. He also said "Family planning and having a planned family decreases pressure to the environment and somehow it gives the environment the time to breathe." He also mentioned that with integrated PHE, there will be more food on the table, couples can send their children to school and have more quality time to spend with their children, community members can have more time to participate in community activities such as coastal cleanup, mangrove planting and reforestation, barangay planning and local governance, which he said are the things that he now observes in Ubay.

"I believe that taking care of and managing the coastal resources in tandem with population management will bring about changes that will benefit not just the present generation but more importantly the future generations. It is comforting to know and with assurance that our children and the children of our children will be able to experience the beauty of nature, have sufficient and sustainable food supply, and enjoying a life of best quality," Jojo further concluded.

Acknowledgements

This documentation was written by Dr. Joan Castro and Dr. Ronaldo Quintana of PATH Foundation Philippines, Inc. (PFPI), a private non-profit, non-stock corporation dedicated to improving health and promoting environmentally sustainable development in the Philippines. The authors would like to thank their colleagues at PATH Foundation Philippines, Inc. – Leona D'Agnes, Enrique Hernandez and Christine Garcia – for their assistance; and the local government of Ubay for cooperation and support. The authors would especially like to thank Hon. Mayor Eutiquio Bernales, Ms. Mercedes Butawan and Mr. Alpios Delima for allowing their stories to be told; and the Institute of International Education – Leadership Development for Mobilizing Reproductive Health (IIE–LDM) for providing funding support; without them, this documentation would not be written.

firefoxLedearship Development for Mobilizing Reprodctive Health - Link